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2019, Number 4

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Ortho-tips 2019; 15 (4)

Aseptic loosening in the total hip prosthesis

Reyes PV

Language: Spanish
References: 27
Page: 206-213
PDF size: 169.53 Kb.


ABSTRACT

Aseptic loosening and osteolysis is the third leading indication for revision total hip arthroplasty. Better understanding of the pathophysiology of osteolysis, causes and preventive measures have significantly decreased ALA prevalence during the past 20 years. Currently 10-15% of revision THR are performed due to AL. From those revisions, 59% require revision of all components, while 41% remaining only require revision of one of them: 13% femoral component, 16% acetabular component and 12% femoral head and linner. The majority of AL are asymptomatic until implant subsidence. In all AL cases, septic loosening must be ruled out. Usually normal ESR and C react protein is enough to rule out infection, although elevated levels obligate further infection work up. Computed tomography is the ideal method to assess and classify osteolysis, and for revision surgical planning. Medical treatment for osteolysis in THR is intended to stop AL progression, reduce pain and increased activity and function. However, once symptoms develop and diagnosis of AL is confirmed, revision surgery is the treatment of choice. Revision can be performed in one or all components, depending of loosening. Bone allograft can help restore bone stock, but metallic augments have the advantage in regards to allowing immediate weight bearing, and earlier physical therapy.


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